{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Mary A St Hilaire","gend":1,"currentgend":"","add":"500 SOUTH WITHAM ROAD","city":"AUBURN","state":"ME","zip":"04210","dob":"1952-10-18","age":"","mstatus":"","insh":"10000082986","cliId":"","pno":2073326681,"cno":"","email":"decline@nomail.com","ename":"","eno":"","pphy":"LATKOVICH, KATARINA Z","ppno":2077955700,"pcpadd":"12 HIGH ST,STE 400 CENTRAL MAINE INTERNAL MEDICINE","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"04240","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"500 SOUTH WITHAM ROAD","madd2":"","madd3":"","mcity":"AUBURN","mstate":"ME","mzip":"04210","pcpfaxno":2077955727,"pcpnpi":1902878499,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"4GR4EN2JV98","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G4733","N3001","J40","Z0101","B9689","R5383","E1142","I10","E785","H47323","H40053","E1140","R09A2","N390","R6883","R109","K219","R0602","R059","Z0000","Z1211","K222","D124","K5730","J069","R0981","Z20822","R079","H04123","M85852","Z780","Z1231","R519","J329","E119","R197","F329","K5900","E538","M6281"],"date":["2025-10-27","2023-04-06","2024-03-02","2025-03-12","2023-04-06","2023-09-12","2025-08-11","2024-03-14","2024-03-14","2023-08-25","2024-02-21","2025-08-05","2023-10-11","2024-04-07","2024-04-07","2024-04-07","2023-10-11","2024-03-02","2024-03-04","2025-03-17","2023-05-15","2023-05-15","2023-05-15","2023-05-15","2024-03-04","2024-03-04","2024-03-04","2025-03-25","2023-08-25","2023-04-18","2023-04-18","2024-11-16","2025-10-11","2025-10-11","2025-10-11","2024-09-18","2023-03-03","2022-10-31","2022-08-23","2022-08-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","BASAGLAR KWIKPEN U-100","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","ULTRA-FINE PEN NEEDLE","","","Select","Select",""],["","","ULTRA-FINE SHORT PEN NEEDLE","","","Select","Select",""],["","","EZETIMIBE","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","VALSARTAN","","","Select","Select",""],["","","DULOXETINE HCL","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","PANTOPRAZOLE SODIUM","","","Select","Select",""],["","","MNEXSPIKE 2025-2026 (12Y UP)","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","AMOXICILLIN-CLAVULANATE POTASS","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","GAVILYTE-G","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","FLUAD QUAD 2023-2024","","","Select","Select",""],["","","SPIKEVAX 2024-2025","","","Select","Select",""],["","","AREXVY","","","Select","Select",""],["","","OMEPRAZOLE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}